The electronic Frailty Index (eFI1)
The electronic Frailty Index (eFI1) is a validated tool used to identify and grade frailty in individuals aged 65 and over. It operates on a cumulative deficit model, using routinely collected data from GP electronic health records to assess up to 36 health deficits. The number of deficits is divided by 36 to produce a score that categorises individuals as:
- Fit: 0–4 deficits
- Mild Frailty: 5–8 deficits
- Moderate Frailty: 9–12 deficits
- Severe Frailty: 13+ deficits
This stratification helps clinicians proactively identify patients who may benefit from targeted interventions before they experience significant unplanned service use.
The eFI1 is based upon a person’s needs, rather than their service use and so it can be used to identify people with lower levels of frailty before they have significant unplanned service use. Therefore these individuals can be targeted with appropriate preventative interventions. All patients within Gloucester have a recorded eFI and two patients can have the same frailty score but a completely different mix of deficits. Rockwood scores utilise a sarcopenia model of frailty rather than a cumulative model. Patients only get a Rockwood upon evaluation by clinician.
The score can be between 1 and 9;
1 = 1 fit,
8 = very severely frail
9 = 9 terminally ill.
Rockwood is only recorded if clinician is concerned about the patient. It can also be done in ED but this is often in a crisis state so is often not reflective of the patients overall status.
Therefore, use of a Rockwood score is good for individual level frailty at a specified time while eFI is more reflective of day to day condition and is better for viewing frailty from a higher population level.
The Gloucestershire Frailty Power Bi report uses eFI as its is better record across our entire population and allows the analysis of high level trends
Integration with Broader Care Models
The eFI is often used alongside tools like the Rockwood Clinical Frailty Scale and Comprehensive Geriatric Assessment (CGA).
NHS England supports the use of eFI as part of the GP contract to identify and support frail patients. It’s considered a key tool in proactive care planning and population health management
(NHSE Electronic Frailty Index)
The electronic Frailty Index version 2 (eFI2)
The electronic Frailty Index version 2 (eFI2) is the latest validated tool for identifying and grading frailty in individuals aged 65 and over. Building on the original eFI1, eFI2 incorporates several key improvements to better predict adverse outcomes and support proactive care.
Key Features
Weighted Deficits: Unlike the original eFI1, which gave equal weight to all health deficits, eFI2 assigns different weights to each variable based on its contribution to frailty risk. This provides a more accurate assessment of an individual’s frailty status
Time Constraints: eFI2 considers the time sensitivity of certain deficits, ensuring that conditions which may resolve over time do not continue to inflate a patient’s frailty score
Refined Frailty Categories: The cut-points for frailty categories in eFI2 are mapped from reference standards, improving the classification of frailty severity
Broader Outcome Prediction: eFI2 is validated to predict a composite risk of:
– New home care package
– Hospital admission for fall or fracture
– Care home admission
– All-cause mortality within one year
How eFI2 Works
eFI2 uses routinely collected data from GP electronic health records, like the original eFI1, but with enhanced algorithms that account for:
– The relative importance of each deficit
– The recency and persistence of health conditions
– Additional variables, including mental health, informed by clinical expertise and literature reviews
Clinical Application
Population Health Management: eFI2 is designed for use at both individual and population levels, enabling clinicians and commissioners to identify those at highest risk and target interventions accordingly
Integration with NHS Digital Strategy: eFI2 supports the NHS ten-year plan’s shift from analogue to digital by leveraging electronic health records for real-time frailty assessment and care planning
Proactive, Preventative Care: By more accurately identifying those at risk, eFI2 helps shift the focus from treatment to prevention, supporting earlier, community-based interventions and reducing reliance on hospital care
Implementation and Guidance
National Rollout: Major GP electronic health record systems in England are adopting eFI2, with NHS England recommending its use as part of the proactive care agenda
Clinical Judgement Still Required: While eFI2 offers improved prediction, it is not a standalone diagnostic tool. Clinical assessment remains essential for formal frailty diagnosis and care planning
EFI2 is not currently embedded within the Gloucestershire ICB or clinical systems (most practices in the county use System 1 rather than EMIS). The BI team have access to the algorithm behind EFI2 and could run it in the future.
Summary:
eFI2 represents a significant advance in frailty identification. By weighting deficits, applying time constraints, and refining frailty categories, it supports the NHS’s move towards digital, preventative, and community-based care, in line with the ten-year plan’s priorities
Useful links
Using the new electronic frailty index (eFI2) to aid frailty identification and management in primary care https://pmc.ncbi.nlm.nih.gov/articles/PMC12117642/
Development and external validation of the electronic frailty index 2 using routine primary care electronic health record data https://academic.oup.com/ageing/article/54/4/afaf077/8101467
NHS England » Electronic Frailty Index
ICBBI0004.02 – Frailty CPG Report – Power BI